Phi Ji Hoon, Chung Chun Kee
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
Neurosurg Focus. 2009 Aug;27(2):E5. doi: 10.3171/2009.5.FOCUS09106.
Surgical treatment of brain tumors in the mesial temporal lobe (MTL) is a highly demanding procedure. Only a few studies describing the surgery of MTL tumors have been reported, and they have been focused on the operative techniques and immediate results of the surgery. The authors have analyzed the long-term oncological outcome in patients with MTL tumors.
Thirty-six patients with an MTL tumor were studied. The mean patient age at surgery was 32 years (range 13-62 years). The tumors were confined to the MTL (Schramm Type A) in 25 patients (69%). Extension of the tumor into the fusiform gyrus (Schramm Type C) and temporal stem (Schramm Type D) was observed in 4 and 7 patients (11 and 19%), respectively. There was a significant difference in the tumor size according to Schramm types (p = 0.001). Complete tumor resection was achieved in 26 patients (72%). All tumors were low-grade lesions except for 1 anaplastic astrocytoma.
After a median follow-up period of 50.5 months, 7 patients showed progression of the disease. The actuarial progression-free survival rates were 97% in the 1st year, 84% in the 2nd year, and 80% in the 5th year. The degree of tumor resection was significantly related to the tumor control failure (p < 0.001) and malignant transformation of a low-grade tumor (p < 0.001). Univariate analyses using a Cox proportional hazards model showed that the following factors were significantly associated with a failure to control the tumor: 1) extent of the tumor (Schramm Type D; p = 0.003, relative risk [RR] 12.04); 2) size of the tumor (p = 0.033, RR 1.052/mm); 3) patient age at surgery >or= 50 years (p = 0.007, RR 8.312); and 4) short duration of epilepsy (< 6 months; p = 0.001, RR 21.54).
Surgery is the principal treatment for MTL tumors, despite its technical difficulty. Complete tumor resection is strongly recommended for long-term tumor control. The MTL tumors are heterogeneous in their prognosis. Older age, short duration of epilepsy, and tumor size are all associated with poor outcome. Patients with these characteristics may have a more aggressive form of the disease than those with MTL tumors associated with chronic epilepsy.
颞叶内侧（MTL）脑肿瘤的手术治疗是一项要求极高的操作。仅有少数关于MTL肿瘤手术的研究报道，且这些研究主要集中在手术技术和手术的即时效果上。作者分析了MTL肿瘤患者的长期肿瘤学预后。
对36例MTL肿瘤患者进行研究。手术时患者的平均年龄为32岁（范围13 - 62岁）。25例患者（69%）的肿瘤局限于MTL（施拉姆A型）。分别有4例（11%）和7例（19%）患者观察到肿瘤延伸至梭状回（施拉姆C型）和颞叶干（施拉姆D型）。根据施拉姆类型，肿瘤大小存在显著差异（p = 0.001）。26例患者（72%）实现了肿瘤全切。除1例间变性星形细胞瘤外，所有肿瘤均为低级别病变。
中位随访期为50.5个月后，7例患者出现疾病进展。1年、2年和5年的无进展生存率分别为97%、84%和80%。肿瘤切除程度与肿瘤控制失败（p < 0.001）和低级别肿瘤的恶性转化（p < 0.001）显著相关。使用Cox比例风险模型进行的单因素分析显示，以下因素与肿瘤控制失败显著相关：1）肿瘤范围（施拉姆D型；p = 0.003，相对风险[RR] 12.04）；2）肿瘤大小（p = 0.033，RR 1.052/mm）；3）手术时患者年龄≥50岁（p = 0.007，RR 8.312）；4）癫痫发作时间短（< 6个月；p = 0.001，RR 21.54）。
尽管手术技术难度大，但手术仍是MTL肿瘤的主要治疗方法。强烈建议进行肿瘤全切以实现长期肿瘤控制。MTL肿瘤的预后存在异质性。年龄较大、癫痫发作时间短和肿瘤大小均与不良预后相关。具有这些特征的患者可能比伴有慢性癫痫的MTL肿瘤患者疾病形式更具侵袭性。
